Abnormal labour

Mahoney, Charlotte; Samangaya, Rebekah; Whitworth, Melissa

doi:10.1016/j.ogrm.2010.04.003

« Previous Next »Obstetrics, Gynaecology and Reproductive Medicine
Volume 20, Issue 7 , Pages 219-224, July 2010

Abnormal labour

Charlotte Mahoney MB ChB is a Subspecialty Trainee in Obstetrics & Gynaecology at St Mary’s Hospital, Oxford Road, Manchester, UK. Conflicts of interest: none declared

Rebekah Samangaya MD MRCOG is a Subspecialty Trainee in Fetal and Maternal Medicine at St Mary’s Hospital, Oxford Road, Manchester, UK. Conflicts of interest: none declared

Melissa Whitworth MD MRCOG is a Consultant Obstetrician at St Mary’s Hospital, Oxford Road, Manchester, UK. Conflicts of interest: none declared

Abstract

Women with a previous caesarean section should be counselled antenatally about delivery options. The success rate of vaginal birth after caesarean section (VBAC) is 72–76%. The risk of uterine rupture is 22–74/10 000. Continuous foetal monitoring, intravenous access and accessibility to theatre are required in all VBAC cases.

Pregnant women with HIV infection should be cared for by a multidisciplinary team. Mother to child transmission of HIV can be reduced to less than 1% with interventions. Antiretroviral therapy is commenced in the second trimester. Mode of delivery is dependent on viral load. Breast feeding should be avoided and babies require postnatal antiretroviral therapy.

Cardiotocograph tracings are categorized as normal, suspicious or pathological. Foetal blood sampling is warranted with a pathological tracing, and can be done from early stages of cervical dilatation. At full dilatation, foetal blood sampling can allow more time for head descent to avoid performing a difficult instrumental delivery.

Keywords: antiretroviral therapy, electronic fetal monitoring, induction of labour, oxytocin, HIV infection, mother to child transmission, vaginal birth after caesarean section